1043875552 NPI number — MRS. NATALYA V FRYAZIN

Table of content: MRS. NATALYA V FRYAZIN (NPI 1043875552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043875552 NPI number — MRS. NATALYA V FRYAZIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRYAZIN
Provider First Name:
NATALYA
Provider Middle Name:
V
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELOSHEVSKAYA
Provider Other First Name:
NATALYA
Provider Other Middle Name:
V
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1043875552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4401 PARK AVE APT 4D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07087-6360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-404-3452
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 60TH ST.
Provider Second Line Business Practice Location Address:
2ND FLR
Provider Business Practice Location Address City Name:
WEST NEW YORK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-430-5233
Provider Business Practice Location Address Fax Number:
201-210-4435
Provider Enumeration Date:
05/09/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  37AC00469200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)